Carriers of both hepatitis B (HBV) and C virus (HCV)
are more often cirrhotic than patients who are positive for
anti-HCV only. So say the authors of this prospective, case-control
study from Italy. However, this relationship is significant only
when the infection has been diagnosed via polymerase chain reaction
(PCR) analysis of the serum and liver.

The authors collected serum samples and performed liver biopsies
on 19 patients who were positive for both hepatitis B surface
antigen (HBsAg) and anti-HCV antibody. They compared this group
with 38 matched controls who were anti-HCV-positive only. All
subjects had had elevated alanine aminotransferase (ALT) levels for
more than 6 months prior to joining the study. The investigators
evaluated HBV and HCV infections using standard serology and
PCR.

Chronic active hepatitis was present in 7 and cirrhosis in 12
patients who were positive for both HBsAg and anti-HCV. Among
patients who were anti-HCV-positive only, 20 had chronic hepatitis
and 18 cirrhosis. Although a higher percentage of patients with
double infection had cirrhosis compared with single-infection
patients, the difference was not statistically significant.

PCR analysis, however, resulted in reclassification of 16
patients (2 who had chronic active hepatitis and 14 who had
cirrhosis) from the control group to the HBsAg-positive and
anti-HCV-positive group. This change resulted in a highly
significant correlation between double infection and the presence
of cirrhosis: 24 of 35 patients (69%) with double infection had
cirrhosis, compared with only 4 of 22 (18%) who had isolated HCV
infection. Chronic active hepatitis was predominant in patients
with HCV infection only.
~ by Villa E, Grottola A and Buttafoco P